Perio Classification English

The 2017 World Workshop established a multidimensional classification system for periodontal health, gingival diseases and conditions, and periodontitis to improve consistency in clinical practice and research. The system distinguishes findings on an intact periodontium (no detectable attachment and or bone loss) from those on a reduced periodontium (attachment and or bone loss due to periodontitis or non periodontitis causes). Periodontal (gingival) health Periodontal health is defined by the absence of clinically detectable inflammation. Clinical gingival health may occur: On an intact periodontium (no attachment or bone loss). On a reduced periodontium, either: In a stable periodontitis patient (successfully treated and currently stable), or In a non-periodontitis patient with reduced attachment from other causes (for example, gingival recession or crown lengthening). For epidemiologic purposes, gingival health is defined as bleeding on probing at fewer than 10% of sites, with probing depths of 3 millimetres or less. In treated periodontitis, periodontal stability is characterized by minimal bleeding on probing (fewer than ten percent of sites), no probing depths of four millimetres or greater that bleed on probing, and no evidence of progressive periodontal destruction. Dental plaque biofilm induced gingivitis Dental plaque biofilm-induced gingivitis is an inflammatory lesion resulting from plaque-host interactions that remains confined to the gingiva and does not extend to the periodontal attachment (cementum, periodontal ligament, or alveolar bone). It may present as: Gingivitis on an intact periodontium. Gingivitis on a reduced periodontium in a non-periodontitis patient. Gingival inflammation on a reduced periodontium in a successfully treated periodontitis patient. The workshop also identified modifying factors that can amplify the gingival response to plaque, including systemic factors such as smoking, hyperglycemia or diabetes, nutritional factors, pharmacologic agents, and sex steroid hormones (for example puberty, pregnancy, and the menstrual cycle), as well as local predisposing factors such as prominent restoration margins and oral dryness. Non dental plaque induced gingival diseases These conditions are not caused by plaque and generally do not resolve with plaque removal, although plaque can influence their severity. They include: Genetic and developmental disorders (for example hereditary gingival fibromatosis). Specific infections (bacterial, viral, and fungal). Inflammatory and immune conditions and lesions (including hypersensitivity reactions, autoimmune diseases, and granulomatous lesions). Reactive processes. Neoplasms (premalignant and malignant). Endocrine, nutritional, and metabolic diseases. Traumatic lesions (physical, chemical, or thermal). Gingival pigmentation (for example smoker’s melanosis or amalgam tattoos). Classification of periodontitis (staging and grading) The 2017 Workshop grouped forms previously labelled chronic or aggressive into a single periodontitis category, and characterized periodontitis using staging and grading. Other distinct forms include necrotizing periodontitis and periodontitis as a manifestation of systemic diseases. Staging, from Stage One to Stage Four, reflects severity and complexity of management based on clinical attachment loss, radiographic bone loss, and tooth loss. For example, Stage One represents initial disease, with interdental clinical attachment loss of one to two millimetres and radiographic bone loss affecting less than fifteen percent of the root length. Grading, from Grade A to Grade C, reflects the rate of progression and risk. Common grade modifiers include smoking status (non-smoker, fewer than ten cigarettes per day, or ten or more cigarettes per day) and glycemic control in patients with diabetes (a glycated hemoglobin level below seven percent versus seven percent or higher). A simple way to interpret the system is to think of staging as the total amount of damage and the complexity of repair, while grading reflects how fast the disease is progressing and what factors are likely to accelerate it.